Zhao Lin, Wu Yu-Peng, Qi Jin-Long, Liu Yong-Qiang, Zhang Kai, Li Wen-Ling
Department of Neurosurgery, the Second Hospital of Hebei Medical University.
Department of Pharmacology, Hebei Medical University.
Medicine (Baltimore). 2018 Nov;97(48):e13247. doi: 10.1097/MD.0000000000013247.
Early and/or late onset in patients with brain injury (BI) is associated with a poorer prognosis, and phenytoin (PHT) is standard of care to prevent seizures. Levetiracetam (LEV), an alternative antiepileptic drug, is associated with less cognitive disruption. The purpose of this study was to evaluate the safety and efficacy of LEV in the prevention of brain traumatic seizures with the standard drug PHT.
Search the publications on comparison the safety and efficacy of LEV against the standard agent PHT in prevention of traumatic seizures in BI to January 2018. After rigorous reviewing on quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest.
LEV was found not more effective than PHT in terms of overall seizure (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.51-1.05; P = .09), and late seizure (OR = 0.64; 95% CI = 0.34-1.19; P = .16) occurrence. However, there is significant difference in terms of early seizure (OR = 0.63; 95% CI = 0.40-0.99; P = .04). Moreover, there were no significant differences in terms of mortality (OR = 0.67; 95% CI = 0.43-1.05; P = .08), or side effects (OR = 1.31; 95% CI = 0.80-2.15; P = .29) between groups.
The meta-analysis showed that LEV prevention of seizures was associated with early seizure rates that were lower than the PHT-prolonged course of treatment. There is no statistically significant difference in the efficacy and safety profile of PHT and LEV in cases of traumatic BI.
脑损伤（BI）患者的早发性和/或迟发性发作与较差的预后相关，苯妥英钠（PHT）是预防癫痫发作的标准治疗药物。左乙拉西坦（LEV）作为一种替代抗癫痫药物，其引起的认知功能障碍较少。本研究的目的是评估LEV联合标准药物PHT预防脑外伤后癫痫发作的安全性和有效性。
检索截至2018年1月比较LEV与标准药物PHT预防BI患者外伤后癫痫发作的安全性和有效性的相关文献。在对质量进行严格审查后，从符合条件的试验中提取数据。所有试验均分析了感兴趣终点的汇总风险比。
在总体癫痫发作（比值比[OR]=0.73；95%置信区间[CI]=0.51-1.05；P=0.09）和迟发性癫痫发作（OR=0.64；95%CI=0.34-1.19；P=0.16）发生率方面，发现LEV并不比PHT更有效。然而，在早发性癫痫发作方面存在显著差异（OR=0.63；95%CI=0.40-0.99；P=0.04）。此外，两组在死亡率（OR=0.67；95%CI=0.43-1.05；P=0.08）或副作用（OR=1.31；95%CI=0.80-2.15；P=0.29）方面无显著差异。
荟萃分析表明，LEV预防癫痫发作与低于PHT延长疗程的早发性癫痫发作率相关。在创伤性BI病例中，PHT和LEV的疗效和安全性方面无统计学显著差异。
